Summary/Abstract: Mothers'Attitudes about Elective Cesarean: Results, Expectations &Satisfaction The incidence of cesarean delivery is rising in the US, reaching 29% in 2004. An unknown proportion of US cesareans are "elective", defined as cesarean delivery in the absence of maternal or obstetrical indication. In 2003, it was estimated that 2- 3% of US births (more than 40,000 deliveries that year) were elective cesarean deliveries. That rate represented a 36% increase over two years. In response to this apparent rapid rise, the NICHD held a State-of-the-Science Conference in 2006 to address "Cesarean Delivery on Maternal Request (CDMR)". Presumably, consumer choice contributes to the rise in elective cesarean. However, a recent survey suggested that growth of elective cesarean may reflect physician, rather than maternal, preferences. In that survey, 9% of new mothers had "experienced pressure from a health professional" to undergo cesarean delivery but less than 1% had elected CDMR. Because of the low incidence of elective cesarean in the survey population, the researchers were unable to explore the attitudes and goals of women who elect cesarean birth. After reviewing these and other data, the NICHD State-of-the-Science Panel concluded that additional research is needed to address the limitations in our current knowledge about CDMR, patient satisfaction after CDMR, and quality-of-life outcomes after CDMR versus other modes of birth. In this proposed research, we will investigate whether the attitudes and expectations of women seeking elective cesarean differ from those of women planning vaginal birth. In addition, we will explore whether satisfaction with the birth experience differs between these two groups. We will recruit women planning elective cesarean and a comparison group of women planning vaginal birth. Using data collected from these two groups, we will address the following specific aims: (1) to investigate differences in birth-related goals between these two groups, (2) to investigate whether planned route of delivery influences satisfaction with the birth experience in these groups, and (3) to describe the decision process regarding mode of delivery. This will allow us to estimate the proportion of elective cesarean delivery that can be attributed to CDMR. Our long term objectives are to understand how maternal expectations and preferences affect decisions about childbirth. This research will be an important step to understanding the role of consumer choice in obstetrical practices. More information on patient expectations, satisfaction, and outcomes is critical to advancing our knowledge regarding the apparent rapid growth of elective cesarean delivery in the US. / Relevance: Mothers'Attitudes about Elective Cesarean: Results, Expectations &Satisfaction With over 4 million births in the US each year, the public health impact of elective cesarean delivery is potentially enormous. A 1% rise in elective cesarean would result in 40,000 additional cesarean births. This project will investigate how maternal expectations and preferences affect decisions about childbirth and will advance our knowledge regarding the apparent rapid growth of elective cesarean delivery in the US.